Exclusive: Bridging Gap In Indian Healthcare System

How India manages to handle such a huge population and with such a little spending is quite interesting, the fact is when you have a very limited resources you use those resources to the maximum.

Mr. Santanu Mishra, Co-Founder, Executive Trustee Smile Foundation

India has made rapid strides in the health sector since independence. However, various eye opening data from NFHS (National Family Health Survey) clearly indicate that access to healthcare still remains a challenge due to the vast and diverse geography & population of India.

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According to a report by Forbes, India spends only around 1.2% of its national GDP towards healthcare and nearly 70% of the population lives in rural areas and has no or limited access to hospitals and clinics. Apart from this, an extremely low doctor-to-patient ratio is a major concern. There is only one doctor per 1,700 citizens in India; the World Health Organisation stipulates a minimum ratio of 1:1,000. Further, the Union Health Ministry figures claim that there are

about 6-6.5 lakh doctors available currently in the country and India would need about 4 lakh more by 2020. Other obstacles in providing optimum primary healthcare services include low budget expenditure, sub-standard infrastructure, inadequate and under-trained staffs, lack of public and private collaboration and the worst of all insufficient incentives.

As per a report by the UN, 25% of the health infrastructure in India that includes doctors, specialists and other health resources is unavailable in rural areas where 72% of India’s population lives. 75% of the health infrastructure is concentrated in the urban areas that are inhabited by only 27% of the population of the country. While the health statistics of rural India continues to be poor, the health status and access to

health for the poor inhabiting urban slums has surfaced to be equally deplorable. Urban slum dwellers suffer from adverse health conditions owing to mainly two reasons – first the lack of education and thus lack of awareness; and second the unwillingness to lose a day’s wage in order to reach the nearest medical facility. Health for underprivileged which is a desperate need, thus remains unaddressed. As a result, cases of poor health among women, malnourishment in children and deaths from preventable diseases in such areas are always high.

“The neglect in even the simplest preventive medical treatment usually leads to a more serious ailment and eventually to deaths.”

The neglect in even the simplest preventive medical treatment usually leads to a more serious ailment and eventually to deaths. The need of the hour is thus a two pronged approach – first to bring quality health care services to doorsteps of the needy and second to promote healthcare awareness and a positive health care seeking behavior among the underprivileged.

Innovative working model

India is unable to cater to the rising demands of immediate medical facilities across the states as a major part of the population continues to reside in remote and hard-to-reach rural areas, suffering and fighting the worst kind of ailments. In such a scenario a mobile health care services delivery system is the most

practical mechanism. To address the situation, Smile Foundation came up with an innovative solution called ‘Smile on Wheels’. This is a unique mobile hospital programme that seeks to address problems of mobility, accessibility, affordability, awareness and availability of primary health care with a special focus on children and women, in urban slums and remote rural areas.

Managed by specialised medical professionals including doctors, pathologists, pharmacists and nurses, Smile on Wheels are mobile units complete with advanced medical facilities like ECG, X-ray, pathological labs, etc. The model helps to provide free health facilities to the underprivileged at their doorsteps, with a special focus on mother and children.

In addition to providing preventive and curative healthcare services, Smile on Wheels also focuses on generating health awareness on gamut of vital issues including ANC/PNC, institutional deliveries, immunization and vaccination, etc The Smile on Wheels programme aims to increase access to healthcare services, through demand based strategies and by providing a comprehensive combination of health services which meets the needs of the impoverished communities.

The Smile on Wheels programme has so far provided healthcare services to more than 10 lakh children and families.

Journey to connected Healthcare

Since the last three years, Smile on Wheels has worked extensively in the disaster-prone state of Uttarakhand. The Mobile Hospital programme works extensively in 23 villages of the Rudraprayag district, benefitting more than 24,500 people every year. Even after marked progress in provision of medical infrastructure and facilities, healthcare remains a challenge in the difficult terrains of Uttarakhand.

Internationally known for its Kedarnath temple, situated near the Himalayas, the state of Uttarakhand is famous for its natural beauty. The state receives frequent rainfall but in the last couple of years it has experienced inundate rainfall. In 2013, Uttarakhand faced one of its worst disasters. Heavy rain swept away

villages in many districts, notable in Rudrayapag, situated at an elevation of 2,936 feet, and inhabited by over 2.3 lakh people.

A major setback that the district faces is healthcare. Healthcare had long been an acute problem in the district. It has only one government run hospital that lacks adequate health facilities. With lack of proper infrastructure and medical aid the residents often have to travel to other districts to get treatment.

During calamities the condition is even worse. The entire district was left to ruins by the heavy floods in 2013, leaving the health system of the region ineffective at a time when the inhabitants needed it the most. The remoteness and undulating terrains made the delivery of the available medical resources difficult. This was when Smile on Wheels started its operations in the Ukimath Block, with support from the Union Bank of India, at first addressing the immediate medical needs of the flood affected families.

Adding to the inaccessibility of healthcare was the extreme poverty in villages of the district. The cost of travelling to a distant medical facility, in addition to losing a day’s wage, is a significant burden

for the poor people. Lack of awareness has been paramount as extremely low education levels translate to lower appreciation of medical symptoms and benefits of modern medical procedures.

All this meant that the villagers had been living with debilitating illnesses for years hence, enduring the pain either without understanding their health problems or by ignoring them.

Since the people could not reach the medical facilities, Smile Foundation decided to take healthcare services to their doorstep by initiating Smile on Wheels mobile hospital programme in the district. However, this was just the beginning of a challenging journey. The project team had to go on door to door visits in every village and conduct rigorous mobilization sessions to encourage villagers to come for a medical checkup and get treated To promote preventive action awareness sessions were conducted combined with behavioral change classes to actively involve the community.

The results have been satisfying. Once the people started visiting the mobile hospital, some only out of curiosity, some hearing about people who had got cured, the project was successful in the

state. The news spread quickly in adjoining villages and demands were made to make the healthcare services available in other blocks too. Last year healthcare services were provided in eight villages which are outside the coverage of the project but were in dire need. During the recent cloudburst incidents in Pithorgarh district, the Smile on Wheels team carried all their equipment and went on foot where vehicles had no access, to reach the unreached.

The project has been functioning in close coordination with the district and block-level hospitals, and cross referrals are made as per requirement. Further government community health workers including ASHA, ANM and Anganwadi workers are engaged and trained from time to time to ensure a long-lasting change in the community. The Uttarakhand floods brought to light the limitations of healthcare facilities in the state, and now our efforts are directed towards supplementing the government health services and bridge the gap between the needs of the villagers and the medical infrastructure in the area, helping build a robust, sustainable and inclusive healthcare system.

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